Provider Demographics
NPI:1518921733
Name:BAPTIST CANCER CENTER
Entity Type:Organization
Organization Name:BAPTIST CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF INTEGRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:G.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5415
Mailing Address - Street 1:PO BOX 13128
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-3128
Mailing Address - Country:US
Mailing Address - Phone:205-715-5904
Mailing Address - Fax:205-715-5928
Practice Address - Street 1:3500 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8908
Practice Address - Country:US
Practice Address - Phone:205-387-0333
Practice Address - Fax:205-387-9604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-14
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529901670Medicaid
ALH553Medicare ID - Type Unspecified